Maggie McKay (Host): Meaningful Medicine is a Novant Health podcast, bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future. Today, I'm sitting down with Dr. Lindsey Prochaska, and we're going to be talking about breast cancer.

Before we get started, I would love to know how cancer treatment became a passion of yours, and what made you become a medical oncologist?

Dr. Lindsey Prochaska: Hi, thank you for having me. Yeah, so oncology is such a rapidly changing field. You know, that's really what drew me to it. And I've always really had a strong interest in women's health. So I think the combination of that alongside with the Med Onc, just made breast cancer a, a good place for me.

Host: And October is typically the month mammograms are on people's minds, but it should be stressed throughout the entire year. So at what age should screening mammograms begin?

Dr. Lindsey Prochaska: Screening mammograms still are going to be starting at age 40. Just to throw out a few, thoughts there though, there are multiple different guidelines sets that do look at different ages to start. And so if a woman researches this, they might see 40, they might see 45, they might even see 50 based on some of the guidelines, but cancer guidelines that we follow are still at age 40. And yeah, I firmly believe that's where they should start.

Host: So let's say you aren't at that age yet. Should women just conduct self exams?

Dr. Lindsey Prochaska: Yeah, I think it's important to conduct self exams. The age of breast cancer tends to be shifting younger, and you know, I think for that reason alone, it's important to just start doing self breast exams. We know that you can have denser breasts that can be a little bit more lumpy when you're younger and I think for a long time that's been a reason to not necessarily do self breast exams, but I think there's never a time when you can call just to make sure. So I think it's always good practice to start and just check yourself out.

Host: And we've been talking about women at average risk, but some women face higher risks due to genetics. So do they need to get screenings earlier?

Dr. Lindsey Prochaska: Yeah. So, you know, historically we've always said if there's a patient with a strong family history that, whenever your mom or your close family member did get diagnosed, we want to start screening about 10 years sooner than an individual patient.

Host: So, let's say you're diagnosed with breast cancer. What treatments are available and how do the options vary based on the stage of a cancer you have?

Dr. Lindsey Prochaska: Yeah, so breast cancer is really divided into different sections. It kind of depends on what is driving your cancer. So if you do indeed have an estrogen positive breast cancer which about 70 to 75 percent of breast cancers are fed by estrogen, then anti hormonal are typically the mainstay of treatment when we're talking about the whole body systemic portion of the treatment.

There's still certainly going to be the surgery role that is needed in early stage breast cancer and oftentimes radiation as well to the breast. But that's very different depending on, like you mentioned, the stage of the cancer and whether it's driven by estrogen or not.

Host: Dr. Prochaska, can you talk specifically about how you determine patients are good candidates for immunotherapy?

Dr. Lindsey Prochaska: Yeah, so I think the last answer brings a good segue there. So it just depends on the type of cancer to determine if that person is a candidate for immunotherapy. So, immunotherapy is really, therapies that are going to enhance our own immune system to go and fight cancer cells. And so, so far, we've really recognized that our triple negative breast cancers, and those are the ones that are not fed viral hormones and are also considered HER2 negative, are going to be the population of patients currently that benefit the most from adding immunotherapy to their treatment plan.

Host: And a lot of times you hear people who have had breast cancer maybe 10 years earlier and it returns. If someone finishes surgery and chemo, what does treatment look like for the rest of their life to ensure it does not return? Or can you?

Dr. Lindsey Prochaska: It's always important to have ongoing surveillance with your oncologist and that's coming in, that's doing visits, that's doing breast exams and really asking and assessing if we have any new symptoms going on or anything that would give us any concern or pause for a recurrence. In the estrogen positive breast cancer patients, they do have ongoing hormone, anti hormonal therapy.

It's typically in the form of a pill that they'll oftentimes be on for five to seven years, so that is more of like a maintenance type therapy. If you've got more of a early stage triple negative or other type of cancer, then maybe they're not going to have the same type of maintenance therapy, but they are going to be checked quite frequently and have very upfront breast exams for typically about five years.

Host: So in closing, is there anything else you'd like to add that we didn't cover about breast cancer that you think people listening should know?

Dr. Lindsey Prochaska: Just get your mammograms, go early, never assume that anything's not a problem.

Host: Thank you so much for sharing this invaluable and important information. We really appreciate your time.

Dr. Lindsey Prochaska: Thank you for having me.

Host: Again, that's Dr. Lindsey Prochaska. To find a physician, visit NovantHealth.org. For more health and wellness information from our experts, visit HealthyHeadlines.org. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thanks for listening to Meaningful Medicine from Novant Health.